Individual provider Active NPI

Surabhi Chandra-Bose Reddy, MD

  • Pediatric Cardiology Physician
  • Los Angeles, CA
National Provider Identifier
1003971888
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
C137131 Issued in CA
Practice address
4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone
(323) 660-2450
NPI assigned
Dec 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X C137131 CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Mailing address

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 660-2450

Other practice location 1

9500 Stockdale Hwy
Bakersfield, CA 93311-3620
Phone (661) 664-1047

Other identifiers 2

IdentifierTypeStateIssuer
164366002MedicaidTX
8M8180OtherTXBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160822001180 CA Practitioner - Cardiovascular Disease (Cardiology) 0042282501 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Hospital Los Angeles Medical Group IncGroup PAC ID 0143126920, 288 clinicians

Practice addresses (Care Compare)

4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone (323) 361-8408

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
137131CAMDClinical Social Worker
C137131CAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Children'S Hospital Los Angeles Medical Group, Inc. CurrentSince Jun 5, 2016 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince May 16, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Texas Children'S Hospital Past Accepting new patients
Chla Teaching Clinics LLC Past Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Chca Conroe LP Past Accepting new patients
Texas Children'S Physician Group Past Accepting new patients
Physicians' Hospital of Murrieta, LLC Past Accepting new patients
Harris County Hospital District Past Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients
Livingston Healthcare Past Accepting new patients
Raj Associates, LLP Pediatric Cardiology Past Accepting new patients
St. Luke'S Community Health Services Past Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients

Locations

11370 Anderson St
Ste 2600
Loma Linda, CA 92354
Phone (909) 558-2890

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

3701 Wilshire Blvd
Ste 600
Los Angeles, CA 90010
Phone (323) 361-3550

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: sreddy1191559@direct.llu.edu

Organizations & group practices 16

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1003971888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-660-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-660-2450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9500 Stockdale Hwy",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933113620",
            "country_code": "US",
            "telephone_number": "661-664-1047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REDDY",
        "first_name": "SURABHI",
        "middle_name": "CHANDRA-BOSE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "C137131",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164366002",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8M8180",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.